Posted: 20/09/2013 at 15:59
Achilles tendinopathy is often persistent and difficult to treat, however with the right management it can improve. I agree with PSC, calf strength is very important. Recent research now suggests that muscle strength may be one of the key areas in tendinopathy.
So how do you progress? Firstly you need to seek out an experienced physio who can do a thorough assessment and determine if it is Achilles tendinopathy and whether it's insertional (where the tendon attaches to the heel bone) or mid-portion (in the middle of the tendon). This is important as these two different types of tendinopathy have different treatments.
Secondly you need to address factors that contribute to the injury. Your weight may well be an issue and so losing weight is likely to help. Also people often do exercises or use treatments that make things worse, particularly stretching. This may sound odd but I wouldn't stretch your calf muscles as this is unlikely to help in the long term. Stretching mainly effects the tendon rather than the muscle, you want a strong, fairly inflexible tendon that can handle the force involved in running, stretching won't help this.
Crucially you need to improve the muscle and tendon's ability to handle load. This can be achieved by strengthening the 2 calf muscles (gastroc and soleus). For years people have focussed just on 'heel drops' on the edge of the step but more recent research shows that calf strengthening (e.g. simple calf raises) can be very effective if a high load is used. By high load I mean doing single leg calf raises lifting your own body weight plus around 10-20kg extra (held in a backpack).
The problem is this is often painful to do initially so I recommend a graded build up. Start with 'isometrics' on 2 legs. Do a 2 leg calf raise but hold it for 30 seconds. Repeat 4 times and do this twice per day. When this gets easy progress to doing this on 1 leg. Isometrics really help settle pain and start gentle loading.
Next up progress to 10-15 calf raises, this time without a hold. When you can do 3 sets of 15 just on your weaker leg start to add extra weight and gradually build up. This extra weight stimulates the tendon to recover - it doesn't damage it.
Ideally you want to do 2 types of calf raise - straight knee (to target gastroc) and with the knee flexed to around 30 degrees (to target soleus). Do around 3 sets of 15 reps of each exercise every other day and give it time. Tendon's take around 3 months to adapt to loading you need to keep strength work up for at least this length of time. It doesn't take long to do the exercises and it is worth it.
I hope that helps and makes some sense!
Let me know if you have any questions, also if you let me know where you're based I can try and recommend a good physio near you.